On the day I joined the Department of Medicine at MGIMS as a senior registrar, Dr. O.P. Gupta walked up to me and, without much ceremony, handed me my first assignment: take the bedside clinical classes for the undergraduates.

The 1978 batch — five years my junior — was preparing for the final MBBS examination that winter of 1982. They became, without quite knowing it, my first guinea pigs.

I had just arrived from Nagpur, three years of residency behind me, a little unsure of myself, and, if I am honest, a little eager to prove that the training I had received there was worth something in Sevagram. So I practised. I rehearsed how I would stand at a bedside, what I would ask first, how I would let a student discover a sign rather than simply naming it for them.

Word gets around a small campus quickly. Within a few months, people were saying that the young doctor from Nagpur taught medicine in a way that held its own next to the department’s senior trio — Dr. O.P. Gupta, Dr. A.P. Jain, and Dr. Ulhas Jajoo. Each of the four of us had a distinct style, and the students, I think, were the better for it. Variety, after all, is the spice of life. I found a corner of my own in the department. It was not a small thing, given how much senior the rest of the faculty was to me — but it was the students’ verdict to give, not mine to claim.

Reading the Body

How did we actually teach bedside medicine? On paper, the task sounds almost too simple.

First came the vital signs — pulse, respiration, temperature, blood pressure — drilled until a student could take them half-asleep. Then came the four organs through which we read the story of an illness with nothing but our eyes, ears, and hands: the brain, the heart, the lungs, the gut.

I had trained in an era before the machines arrived. Ultrasound and echocardiography were still somewhere in the future. CT scanners and MRI had not yet found their way into any radiology department I knew. Biochemistry offered barely a dozen simple tests. Microbiology meant a microscope and a handful of routine cultures. A thyroid profile was not something you could casually order. Glycated haemoglobin was a phrase nobody used. Troponin had not been discovered. What we take for granted today — a blood test back within the hour, an answer on a screen — either did not exist or took a great deal of trouble to obtain outside the medical college.

So the patient’s history became, by necessity, our most important investigation.

I spent hour after hour with undergraduates, turning over with them the bones of a good medical narrative: who, what, when, where, why. Then came the physical signs, and, more important than the signs themselves, the reasoning behind them. Why does the chest wheeze in asthma but crackle in pneumonia? Why does breath sound bronchial over a lung gone solid with infection? Why does a narrow mitral valve produce that particular rumble in mid-diastole, and a leaking aortic valve that soft, blowing murmur instead? What is a pericardial rub, and why does it come and go with the heartbeat and the breath both? How do you judge the size of a heart with nothing more than the flat of your hand and a few taps of the finger against the chest wall?

I taught the students that there was a method to feeling for an enlarged liver or spleen — that the hand had to move a particular way, patient and unhurried, or it would miss what it was looking for. I showed them how a chest full of fluid sounds different from a healthy one when you tap it, and how a swollen abdomen tells you, if you know how to ask, whether the fluid inside is free to move.

Then came neurology, which the students always found the most forbidding and, I suspect, secretly the most thrilling. We went through the signs one by one: the cranial nerves, the grading of muscle power, the tap of the reflex hammer against a tendon, the scrape of a scooter key along the sole of a foot to watch which way the big toe turned, the careful mapping of where sensation and vibration were lost on a limb and where they were not.

And finally, the hardest part of all — showing them how to take these dozen small observations and stitch them into a single diagnosis.

The Trial in the Seminar Room

The same rigour, perhaps more of it, went into training the postgraduates. Every week we gathered in the departmental seminar room for case presentations.

A postgraduate student would present a short case or a long one. The four of us sat at the front like a bench of judges — a habit, I confess, we had simply inherited from our own teachers, who had been no gentler with us. We picked apart nearly every sentence the poor resident spoke.

For the student standing at the front, it was an ordeal. I have seen otherwise composed young doctors go pale before these sessions. When the two hours finally ended, you could watch the whole room exhale at once.

And yet — looking back at it now, from a safe distance — those hard sessions were what sharpened them. It was in that seminar room, not in any lecture hall, that a resident’s clinical edge was ground fine. Later, in practice, many of them could arrive at a difficult diagnosis simply by listening carefully to a patient’s story and laying their hands on the body — a skill that, I have noticed, doctors trained elsewhere often never quite acquire. MGIMS and GMC Nagpur both took this discipline seriously, each in its own way, and between them they sent out generations of physicians who knew how to examine a patient before reaching for a test.

Chalk, Calligraphy, and the Lecture Hall

Then there were the theory lectures.

In the early years, these were held in Adhyan Mandir, a modest hall across from the old Kasturba Hospital. Later we moved to the new hospital building, into a large hall we simply called the Anatomy Lecture Hall, which could seat two hundred students at a stretch.

The classes brought three batches together under one roof — the freshly minted Second MBBS students, the ones in the middle of their course, and the seniors about to sit their finals. The hall was always full, and it had its own unwritten seating chart, handed down, as far as I could tell, without anyone ever writing it down: the Final MBBS batch took the front benches, the middle batch sat in the middle, and the newcomers occupied the back rows, understanding perhaps half of what was said but sitting up a little straighter all the same, aware that walking into that hall was itself a kind of rite of passage.

The Department of Medicine had its slot every Tuesday and Thursday at eight in the morning. For the better part of three decades, whenever my turn came around, I walked into that hall at the same hour, on the same two days, and picked up the chalk.

I never once used a slide. I trusted the blackboard.

My handwriting happens to be neat — an accident of some early schooling, I suspect, rather than any virtue of mine, and rare enough among doctors that people remarked on it. Two of my former residents, Kaustubh Gokhale and Manoj Singh, told me years later that they used to sit up late in the wards practising my capital D — the sharp downstroke, the quick loop at the base, the full curve sweeping back to close it. I still find that more touching than any compliment about the lectures themselves.

Before I walked into that hall, I mapped out in my head exactly how I would use every inch of that blackboard over the next sixty minutes. I carried no notes. I held no sheet of paper. The lecture lived in my memory, rehearsed the night before, the way an actor might run through his lines before curtain.

Over the years I taught everything the timetable asked of me — neurology, cardiology, pulmonology, gastroenterology, endocrinology — and the emergencies that no textbook chapter can fully prepare you for: snakebite, organophosphate poisoning, diabetic ketoacidosis, heart failure, rheumatic heart disease, tuberculosis, pneumonia, cirrhosis, ulcerative colitis, the autoimmune diseases that mimic everything else until they don’t.

The Era of Handwritten Slides

Every Friday, one of the four of us presented at Journal Club, drawing mostly from the BMJ, The Lancet, JAMA, and NEJM.

There were no computers in Sevagram in those days — they arrived nearly two decades later, somewhere around the turn of the millennium. To show data to a room, we used an epidiascope. We wrote our summaries by hand on paper, in blue, black, and red sketch pens, and the machine threw the image up onto the wall for everyone to see. Later, paper gave way to transparent plastic sheets and proper markers. PowerPoint, when it finally arrived, felt like a different profession altogether.

Call it an old man’s nostalgia if you like, but those handwritten slides, wobbly lines and all, felt more honest to me than the polished decks I see today. I watch my residents now generate a beautiful slide deck with artificial intelligence in the time it used to take me to sharpen a sketch pen. Technology moves on, as it should. But I still catch myself looking back at those hand-drawn diagrams — a crude sketch of a heart valve, an arrow pointing the wrong way that someone corrected mid-lecture — with something close to affection.

I worked hard for those Friday mornings all the same. I would pick three or four landmark trials from the recent journals and try to show, as plainly as I could, how a randomised controlled trial in a foreign journal could bear on the patient lying in the ward downstairs. If nothing else, I hope it taught our residents to read research with a little more scepticism, and to keep pace with a field that never quite stops changing under your feet.

A Full Circle

This is, more or less, how life unfolded for me in Sevagram.

When I joined medical college in Nagpur, all those years ago, I never once imagined I would end up a teacher. My ambitions were modest enough: an MBBS degree, and a small general practice somewhere in Wardha.

Life, as it tends to do, had other plans. I never did open that practice. Instead I stayed inside the walls of a teaching hospital, learning, every single day, a little more about how to practise medicine and how to hand that practice on to somebody younger.

It has given me a quiet sort of satisfaction, the kind that does not need announcing.

Over the years I have taught close to forty-five batches at MGIMS. The classes grew from sixty students in the early days to a hundred. Today, by my rough count, nearly three thousand of my former students are practising medicine somewhere in the world.

Let me be honest about this: if they turned into fine physicians, it was not chiefly my doing — and there are days I suspect it happened in spite of me as much as because of me. I gave them what I could, in the time I had. That is a small enough thing to be proud of, and I would rather leave it at that.